Provider Demographics
NPI:1619016375
Name:SALTERS CREEK MEDICAL GROUP
Entity type:Organization
Organization Name:SALTERS CREEK MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEELE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:757-812-9809
Mailing Address - Street 1:100 BRIDGE STREET
Mailing Address - Street 2:#D
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669
Mailing Address - Country:US
Mailing Address - Phone:757-723-1899
Mailing Address - Fax:757-723-5425
Practice Address - Street 1:183 WOODLAND ROAD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663
Practice Address - Country:US
Practice Address - Phone:757-723-1899
Practice Address - Fax:757-723-5425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104001272111N00000X
VA0101053117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BCBS330020OtherBCBS
B55745Medicare UPIN
5617855Medicare ID - Type Unspecified